Triglyceride-glucose index as a predictor of one-year mortality in non-diabetic acute ischemic stroke

Abstract

Background: Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality, and identifying reliable prognostic markers is crucial for improving outcomes. The triglyceride-glucose (TyG) index, a surrogate marker for insulin resistance, has been associated with adverse cardiovascular outcomes. However, its role in predicting stroke prognosis, particularly in non-diabetic patients, remains unclear. This study aimed to explore the association between the TyG index and one-year outcomes, including mortality, recurrence, and adverse functional outcomes, in non-diabetic IS patients.

Methods: This prospective cohort study included AIS patients without diabetes from multiple hospitals. Baseline data, including the TyG index, were collected at admission, and patients were followed for one year. The primary outcomes were all-cause mortality, stroke recurrence, and adverse functional outcomes, defined as modified Rankin Scale (mRS) >2. Multivariate logistic regression and subgroup analyses were conducted to assess the predictive value of the TyG index for these outcomes.

Results: Among the study population, 5.9% died within one year. The TyG index and its quartiles were significantly associated with one-year mortality, even after adjusting for confounding factors. Patients in the highest TyG quartile (Q4: TyG ≥ 8.9002) had a 3.72-fold higher risk of mortality compared to those in the lowest quartile (P = 0.013). Subgroup analysis showed that the TyG index was a stronger predictor of mortality in men and non-atrial fibrillation patients. Although the TyG index was not significantly associated with stroke recurrence or adverse functional outcomes in the overall cohort, it acted as a protective factor for recurrence in younger patients (< 65 years).

Conclusion: The TyG index is an independent predictor of one-year mortality in non-diabetic IS patients and may aid in risk stratification, particularly in men and younger patients. Its potential role in predicting recurrence and functional outcomes warrants further investigation.

Keywords: ischemic stroke; mortality; non-diabetic; recurrence; triglyceride-glucose index.

Figure 1

Flow chat of participants selection. Image showed that 4680 patients with ischemic stroke were included in this study, from which 2050 patients with diabetes were excluded. Subsequently, 2630 non-diabetic ischemic stroke patients were included, but 789 patients were excluded due to the lack of data on fasting glucose and fasting triglyceride. During the 12-month follow-up, another 438 patients were lost to follow-up. Finally, 1403 patients were included in this analysis.

Figure 2

Subgroup analysis of the relationship between TyG index and one-year post-stroke mortality in non-diabetic patients. Image 2 showed that the mean TyG index (standard deviation), adjusted relative risk (95% confidence interval), P value,and interaction P value across different subgroups. Among these, the TyG index was a risk factor for death within one year after stroke in the male, non-smoking, non-sedentary, hyperhomocysteinemia, and non-atrial fibrillation subgroups (P<0.05), while its predictive role was not significant in other subgroups. Additionally, there was an interaction between the TyG index and gender and smoking status, which together influenced the mortality rate one year after stroke (P<0.05).

Figure 3

Subgroup analysis of the relationship between TyG index and one-year post-stroke recurrence rate in non-diabetic patients. Image 3 displays the mean TyG index(standard deviation),adjusted relative risk(95% confidence interval), P value, and interaction P value across different subgroups. Among them, for individuals under 65 years of age,an increase of 1 unit in the TyG index was associated with a 49% reduction in the risk of stroke recurrence (P=0.022), and there was an interaction between the TyG index and age group,which together influenced the recurrence of stroke one year after the event in non-diabetic patients(P<0.05).In other subgroups, the impact of the TyG index was not significant. However, the TyG index interacted with age groups and hyperhomocysteinemia status, jointly influencing the recurrence of stroke one year later(P<0.05).

Figure 4

Subgroup analysis of the relationship between TyG index and one-year post-stroke adverse functional outcomes in non-diabetic patients. Image 4 showed the mean TyG index(standard deviation), adjusted relative risk(95% confidence interval), P value,and interaction P value across different subgroups. It was found that among people under 65 years old, for every one-unit increase in the TyG index,the risk of adverse outcomes after stroke increased by 47%(P=0.037), and there was an interaction between age group and TyG index, which together influenced the incidence of adverse outcomes one year after stroke in non-diabetic patients (P<0.001). While the TyG index did not significantly influence adverse outcomes one year after stroke in other subgroups, it interacted with age groups, hyperhomocysteinemia status, and a sedentary lifestyle, collectively affecting the poor functional outcomes (P<0.05).